The Irish smoking ban miracle

Another smoking ban miracle, this time from Ireland and this time not limited only to heart attacks but to, well, nearly everything...

Following the implementation of the ban, an immediate 13% decrease in all-cause mortality was observed (RR: 0.87; 95% CI: 0.76–0.99).

Boom. Take that, sceptics!

Mortality decreases were primarily due to reductions in passive smoking.

Blimey. No quibbling about correlation and causation for these folks.

Who are these folks, anyway? Step forward Luke Clancy, currently of the Tobacco Free Research Institute, previously the chairman of ASH Ireland and the lead figure in the smoking ban campaign back in 2003. What better man to mark his own homework?

Let's return to that extraordinary claim...

Following the implementation of the ban, an immediate 13% decrease in all-cause mortality was observed (RR: 0.87; 95% CI: 0.76–0.99).

What does "immediate" mean here? Overnight? Within a month? A year? The authors do not tell us, but they also—quite rightly—look at diseases which they don't think are caused by passive smoking (a small and dwindling category) to use as a control.

In contrast, an immediate 15% decrease was observed for non-smoking related mortality (RR: 0.85; 95% CI: 0.75–0.97)

Doesn't that undermine the central claim?
 

...followed by a 5% increase each post-ban year (RR: 1.05; 95% CI: 1.02– 1.08).

Phew! That's alright then.

For ages 35–64 years, an immediate post-ban decrease in all-cause mortality was observed (RR: 0.79; 95% CI: 0.67–0.93)

Huzzah! So the smoking ban saved lives in the 35-64 age group then?

...followed by annual trend increases in all-cause mortality (RR: 1.06; 95%: 1.02–1.10), resulting in a net post-ban increase of 2%.

Maybe not. It seems that if you weren't a pensioner, the smoking ban was bad for your health (if, like Clancy et al., we assume that correlation = causation).

Of course, it is mainly pensioners who die of cancer, heart disease, stroke etc., even if it is mainly younger people who go to pubs and workplaces, and we know that all-cause mortality has been declining for years (see top blue line).

The graph below, also published by Ireland's Department of Health, tells much the same story but brings us up to 2011...

The Irish smoking ban was introduced in March 2004. Can you spot the dramatic decline in mortality around 2004-05? To me, it looks very much the existing downward trend continued and, if anything, slowed down in the post-ban period.

In the end, Clancy et al. resort to apply the statistical trick method of simply guessing how much higher rates of disease might have been if Clancy hadn't succeeded in getting the Irish government to ban smoking in 'public' places.

In the absence of a national smoking ban, an estimated 3,726 (95% CI: 2,305–4,629) additional smoking-related deaths would have occurred.

With that bit of 'science' completed all that remains is to type out the study, issue the press release and wait for the media to announce...

Smoking ban saves 3,700 lives thanks to cleaner air

All in a day's work for tobacco control.

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John Dalli - the facts finally emerge

After months of rumour and conspiracy theory, the results of OLAF's investigation into former EU Health Commissioner John Dalli have been made public. (For background information go here, here, here and here.) The following points are now clear:

1. John Dalli's friend, Silvio Zammit, attempted to solicit a bribe from Swedish Match, claiming that he was working on behalf of Dalli and could get the snus ban overturned. This is confirmed by a recorded telephone conversation. Neither Zammit nor Dalli's friends in the Maltese and EU media are denying this aspect of the investigation.

2. OLAF has indeed uncovered "unambiguous and converging pieces of circumstantial evidence" that Dalli knew about Zammit's attempt to solicit a bribe. Phone records show that Zammit attempted to call Dalli during his first meeting with a representative of Swedish Match on 21 October 2011 and spoke to him later that afternoon. Thereafter, there were 23 phone calls or text messages between Dalli and Zammit between 5 January 2012 and 17 July 2012. Of these, 17 were made "immediately before, after or on the same day" as key events in the Zammit bribery timeline. These include Zammit calling Dalli just seven minutes after speaking to a representative of Swedish Match on 29 March and Dalli calling Zammit twice later the same day, less than two hours after the (recorded) conversation in which Zammit attempted to solicit the bribe.

If Zammit and Dalli were in constant contact, these phone calls at crucial moments could be dismissed as coincidence. However, they spoke on the telephone relatively infrequently. For example, after 13 April, the phone records show no contact between the pair, but on 17 and 18 June—shortly after OLAF began its investigation—several phone calls were made. There were then no more phone calls until Dalli phoned Zammit on 6 July—a day after OLAF interviewed Zammit as part of the investigation.

3. Dalli has been changing his story. OLAF notes that he initially denied meeting Zammit on the 10 February 2012. He has since admitted that this meeting did, in fact, take place. Other aspects of Dalli's story do not stack up. In light of the phone calls made between Dalli and Zammit in mid-June and early July, after OLAF had interviewed Zammit and a third Maltese individual Gayle Kimberley, OLAF says that: "It is not realistic to believe that they did not talk about the matter under investigation and OLAF's latest intervention." However, when OLAF interviewed Dalli on the 16 July, he claimed to have been unaware of the investigation until several days after these phone calls were made.

OLAF has found inconsistencies and contradictions in the accounts of all three 'persons of concern' (Dalli, Zammit and Kimberely). By contrast, the accounts given by representatives of Swedish Match are consistent with each other and with the telephone evidence. The OLAF report supports what Swedish Match has been saying from the outset. They were approached by Zammit, claiming to act on Dalli's behalf, who attempted to solicit a bribe of €60 million to overturn the snus ban. They declined this offer, tape recorded a phone call as evidence and reported him to OLAF.

It remains to be seen whether Dalli's involvement in this sordid affair can be proven beyond reasonable doubt in a court of law. All the evidence in the OLAF report is consistent with the theory that Dalli was, at the very least, aware of Zammit's approaches and failed to report him. There is no doubt that Dalli is/was close to Zammit, and one has to ask why Zammit would request a bribe if he had no way of getting Dalli to overturn the snus ban. If Dalli had not been involved and Swedish Match had paid up, what was he going to do? Run away with €60 million?

It also remains to be seen whether the EU's 'public health' lobbyists and their friends in the media will drop their conspiracy theories, stop their smearing of OLAF and finally distance themselves from this man now that the facts are in the public domain.


You can read the OLAF report here.

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Denmark abandons the soda tax

Completely ignored by the British media, Denmark is abandoning its soda tax and is cutting beer duty because—guess what?—it turns out that simplistic 'public health' policies have unintended consequences.

A soda tax in Denmark didn't lead to people drinking fewer sugary beverages. Instead, they just headed next door to Germany, where sodas were cheaper.

Well, I'll be damned. In short, the Danes have had the same experience with the soda tax as they did with the disastrous fat tax.

The decision comes months after the government in Copenhagen repealed a similar tax on foods with high concentrations of saturated fats -- dubbed the world's first "fat tax." The measure was introduced with the intent to incentivize healthier eating, but authorities said it ultimately just drove up food prices and put jobs in jeopardy.

The message is clear. These policies are unpopular and people will search out cheaper alternatives whenever they can find them. Happily, the Danish government has come to terms with reality and is now rolling back prices.

The tax on soft drinks is to be halved by July and completely abolished by next year, making a 1.5-liter bottle of soda three kroner (€0.40) cheaper in the end. The lesser tax on beer is to be cut by 15 percent by July.

Finance Minister Bjarne Corydon told public broadcaster DR on Monday that the tax's repeal, which has broad support in parliament, would provide a "powerful growth spurt" to the Danish economy.

The same bone-headed 'public health' lobby that cried salt tears when the fat tax was dropped will doubtless complain that Denmark's (left-wing) government is putting financial considerations before health. There is, however, no evidence that either tax had any effect on health. Moreover, since these lobbyists' main justification for state interference in the nation's diet is that fatties cost the government money, they can't—or at least shouldn't—complain when governments try to save money.

Taxing 'unhealthy' food and drink remains a key priority for the public health industry, not least in the UK where a concerted campaign has been underway since the start of the year. Campaigners have so many computer models showing that these sort of taxes will be a terrific success that they are able to shrug off real world evidence such as Denmark's. Group consensus and computer models are reality in the public health bunker. But the fact remains that a country not so far from Britain has experimented with a fat tax and a soda tax in good faith but has swiftly abandoned them because (a) they don't work, (b) they are unpopular, and (c) they have unintended, albeit predictable, consequences which are bad for the economy.

Lesson learned? If only.

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Peter Kellner can't keep quiet

For reasons that now escape me, I went to a Fabian Society event at the 2009 Labour Party conference (it was in Brighton, where I was then living—I can think of no other excuse). It was there that I picked up a free copy of Fabian Review which featured an article warning about "the danger that the Conservatives might win" the forthcoming election (see left). Nothing unusual about that in a socialist magazine, but I was slightly surprised to see that it was written by Peter Kellner, president of the opinion polling company YouGov and the BBC's go-to man for election analysis. I knew that Kellner was a bit of a lefty, but I didn't realise he was such an active Labour supporter.

YouGov are the pollsters of choice for ASH on whose board Kellner also happens to sit. He chaired the editorial board for ASH's 2008 'Beyond Smoking Kills' report, for which YouGov provided survey data (which, by the way, found that plain packaging was the least popular of the twelve proposals put forward) and he is in the habit of writing open letters to politicians calling for neo-prohibitionist legislation.

Today, he has sent an e-mail from his YouGov account making a final plea for plain packaging (a shorter version of which is published at the Huffington Post). He gives four lame reasons why ministers should embrace 'standardised packaging', starting with the claim that "it would be popular" based on a YouGov poll—tellingly, he does not mention the public consultation.

Reason number two is that it "would be cheap"—questionable, but so what anyway? I can think of dozens of stupid laws that would be cheap.

Reason number three is that "there is a real prospect that, over time and in conjunction with other reforms, fewer teenagers would take up smoking"—faint praise indeed; even a trustee of ASH can't bring himself to go beyond vague aspirations and even these require "other reforms" to go alongside it.

Reason number four is that "this is the least disruptive" of the recent neo-prohibitionist policies because, for example, "it does not force smokers to change their habits in pubs or office"—again this is questionable, but even if it were true it would be irrelevant.  

Kellner then gives what he mischievously calls the case against the legislation, namely:

1. The tobacco industry doesn’t like it.

And that’s about it.

How very droll. Except that there is a host of reasons given by politicians, policeman, libertarians, customs officers, brand experts, packaging companies and intellectual property lawyers which Kellner neglects to mention. The irony is that "the tobacco industry doesn't like it" is actually the number one reason why the tobacco control lobby wants to introduce plain packs. The policy passes what these puerile idiots call "the scream test"—ie. if the industry protests, it must be worth doing. They know—and occasionally admit—that the industry's real concern is that they will sell fewer premium brands, not that they will sell fewer cigarettes in general, but annoying the industry is more important to them than reducing the smoking rate.

Kellner is obviously entitled to his opinion, but there is something rather undignified about the president of a polling organisation making a last ditch effort to rally the troops. I thought that in Brighton in 2009 and I think it still.

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Never saw that coming

From Dr Kerryn Phelps, former president of the Australian Medical Association...

Like night follows day.

h/t The IPA

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Silencing the opposition

There is touch of McCarthyism in the air. It is not enough for the temperance lobby to have the loudest voice in the room. Their opponents must also be silenced.

Last week's SHAAP report (currently offline*) was part of a growing campaign to treat the drinks industry like the tobacco industry. In particular, the temperance lobby would like to see 'the liquor trust' subject to something like Article 5.3 of the FCTC. Article 5.3 says that tobacco policy should be protected from "commercial and other vested interests of the tobacco industry". This is not unreasonable, but the instruction has since been interpreted by various governments, including the EU, to mean 'don't talk or listen to the tobacco industry'. Since it never occurs to regulators to listen to consumers or the general public, the effect has been to create an echo chamber in which state-funded NGOs lobby the state for neo-prohibitionist measures. Having silenced the opposition, the NGOs are able to made absurd claims without being held to account.

Any lobby group would love to find itself in such a privileged position. As 'alcohol control' increasingly relies on junk science and rigid ideology, demonising the opposition and silencing critics is an urgent priority. Step forward Alcohol Research UK, an allegedly non-partisan organisation which used to produce some decent research, but now publishes propaganda like this.

The alcohol industry has been accused of distorting evidence in an attempt to influence the Scottish government over its minimum pricing policy.

Academics examined submissions made by the industry to the government's public consultation in 2008.

They said their research suggested the responses had "ignored, misrepresented and undermined" scientific evidence.

The 'study' is here and what a mess it is. The thesis is that there is One True Alcohol Policy which has been approved by science and which is being undermined by "commercial interests" who dare to cast doubt on it. The implications are obvious, but the authors hammer them home for the benefit of obtuse readers.

These tactics mirror those of the tobacco industry, to which some producer organisations are closely related. Unlike the tobacco industry, which has been excluded from direct influence in policy making in many countries, alcohol industry actors continue to exercise strong influence on alcohol policies across the world... An important tactic in contemporary corporate lobbying, pioneered by the tobacco industry, is the construction of doubt about the content of scientific evidence, and this may underlie the approach taken in these submissions.

The authors conspicuously fail to mention that 'what should be done about alcohol pricing?' is a fundamentally different question to 'does smoking cause lung cancer?' The latter is a question that can be answered by science, whereas the former is a question of costs and benefits. We can make alcohol cost £10 a unit with the reasonable expectation that this will reduce alcohol consumption but that does not mean we should do so. What are the unintended consequences? Would it be a proportionate response? What are the costs to the public? What are the implications for liberty? There is no scientific answer to the question of whether a policy is reasonable, proportionate or fair.

Moreover, the question of minimum pricing necessarily involves speculation. One of the more absurd and troubling developments in this pocket of academia in recent years has been the conceit of portraying estimates based on untried—and often dubious—assumptions as proven science. Minimum pricing might reduce alcohol-related harm, or it might increase it, or it might do nothing, or it might have unintended consequences which outweigh the possible benefit to 'public' health. There are plausible reasons for each of these possibilities and different opinions should be heard and respected.

Obviously, we expect the drinks industry to put forward reasons why the state should not seize control of the pricing mechanism. Equally obviously, we expect the temperance lobby to recommend higher prices, restrictions on availability and bans on advertising—they've been saying that since the 1820s. It is the job of politicians to assess these competing claims and to balance different interests, including the interests of drinkers.

the study accused Asda of making "unsubstantiated claims" about the adverse effects of the policy proposals, which the supermarket chain said would "create incentives for the black market and criminals and illegal door to door sales."

Notice how Asda has become part of the drinks industry in the eyes of these people. Notice also how Asda clearly has a point. Is Alcohol Research UK seriously claiming that higher prices do not create incentives for the black market? If so, I wonder what they think does provide incentives if not profit? How strange that the temperance lobby's case for minimum pricing rests on (a naive understanding of) the law of demand and yet they dismiss the law of supply as a drinks industry myth.

The report, which was funded by the charity Alcohol Research UK, stated: "The Portman Group made unsubstantiated claims that the proposals could "increase the appeal of alcohol to young people by creating a 'mystique'" and thereby "turning alcohol into a 'forbidden fruit'".

Well, it might. Or it might not. We don't know, but there are plausible reasons to think that banning advertising, for example, might well create a certain mystique around alcohol. It does not seem ridiculous to suggest that forbidding something might give it a "forbidden fruit" appeal. Note that the authors of this study are not merely disagreeing with this suggestion, but are asserting that it is demonstrably false and that the mere mention of it amounts to the "construction of doubt about the content of scientific evidence". This goes beyond smear tactics. These people are saying that they can predict the future with 100% certainty and everybody else should shut up.

we suggest that the public interest is not served by industry actors’ involvement in the interpretation of research evidence.

There is no such thing as the 'public interest' and even if there were it could not be objectively defined by the sociologists who wrote this study (yes, it's sociologists again). There are competing interests which need to balanced. The whole point of having a public consultation is to hear different views from different interests. If there was a scientifically proven One True Alcohol Policy we wouldn't need public consultations or democracy, we would just hand over the levers of power to social scientists. And wouldn't they like that?





* The SHAAP report has been temporarily taken offline after Dave Atherton pointed out to them that Freedom2Choose is not, as it claimed, funded by the tobacco industry. And they have the nerve to accuse others of playing fast and loose with the facts...

UPDATE

James Nicholls from Alcohol Research UK has e-mailed me to stress that the conclusions of this study do not necessarily reflect the view of the organisation. I'm happy to clarify that Alcohol Research UK funded, but did not conduct, this study.

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Crack cocaine or moral panic?

Today sees the publication of a new IEA report in which I look at the current controversy over virtual gaming machines (AKA fixed odds betting terminals—or FOBTs). These machines give people a bit of fun and entertainment in their lives, so naturally there is a campaign to ban them. The report looks at the various claims made by campaigners and finds them to be deeply misleading if not demonstrably false.

You can download it here and I've written a short blog post about some of the most pervasive myths here.

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